Childhoodobesity is apublichealthproblemofglobal significance. The medical and psychosocial comorbidities of childhood obesity areextensive, and thedisorder is costly to individual childrenandsocieties.Particularlychallenging is the “tracking”ofobesity1: obese children tend to become obese adolescents, who in turn tend to become obese adults and harbor itsmanycomorbidities.Althoughthis certainly isnot trueofall obese children,environmentalandbiologicalpressurescanunderminesuccessful weight loss even among the most determined families. For these reasons, the prevention of childhood obesity is an internationalpriority.However, controlled intervention trials striving toprevent childhood obesity are scarce, and even rarer are those occurring in the first2yearsof life.Thispresentsan importantopportunity for innovativeearlyobesitypreventionstudies, guidedby recentdiscoveries of biological and behavioral mechanisms. In this context, the 2013 conference hosted by the National Institute of Diabetes and Digestive and Kidney Diseases on infancy and early obesity prevention was an important event. The resulting working group report was published in the May 2015 issue of JAMA Pediatrics.2 The report summarized what is currently known about obesity prevention in infancy and early childhood. Knowledge gaps and research needs were identified, including the need to better understand how obesity is influenced by infant weight and length (and how these relate to reference standards), infant body composition, intrauterine factors, rapid weight gain in infancy, physical activity, sleep, feeding modality (eg, bottle vs alteration in milk flow), food preferences and appetitive behavior in infants, formula and breast milk composition, complementary feeding, social cognitive variables (eg, parent or sibling behaviors), behavioral phenotypes (eg, food preferences, temperament), infant emotion and behavioral regulation, maternal feeding values and beliefs, and emerging risk factors (eg, hormonal milieu, microbiome). The report by Lumeng et al2 will stimulate new multidisciplinary research that has not been explored to date. As this process unfolds, a natural partner for collaborative research will be primary care pediatrics—ie, pediatricians, family practice physicians, nurses, and other health professionals at the clinic. (These professionals also work in many school clinics.) Primary care clinicians have long-standing relations with children, are on the front line with families, and are the authority to whom parents turn so often for guidance. Moreover, primary care is rapidly becoming a pivotal repository for “big data” collection about patients—ie, electronic medical records (EMRs). For this and other reasons, primary care clinicians should be considered invested stakeholders in advancing the research agenda of the National Institutes of Health (NIH) working group. As theNIHdevelops a strategy for investigating childhoodobesity, how can primary care clinicians contribute? The overall research effort should capitalize on interventions that can already be implementedbyprimary care clinicians. A recent reviewofprimary care interventions for childhoodobesitydispels thenotion that this intervention is not effective. Overweight or obese children treated inaprimary care settingorwithhelp fromaprimaryhealth careprofessional showed significant improvements compared with controls foranthropometric,metabolic,andbehavioraloutcomes.3Studies of primary care interventions for obesity, in general, are limited bysmall sample sizes, lack follow-upassessment, anddiffer inmethodological rigor, highlighting the need for further research. Results from a family-based behavioral intervention conductedat4 largeurban/suburbanpractices inNewYorkareencouraging, with 105 families randomized to treatment.4 Children assignedtoreceivefamily interventioncomparedwithcontrolachieved JAMA Patient Page page 850 JAMAPEDIATRICS
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